title: Interdisciplinary treatment of an adolescent with unilateral cleft lip and palate.
abstract: OBJECTIVE
  The present case report describes the importance of interdisciplinary approach and gives an understanding on management of an adolescent with unilateral cleft lip and palate.
  
  
  BACKGROUND
  Failure of fusion between medial nasal process and maxillary process or between the palatal process leads to the formation of clefts. Clefts are result of genetic or environmental factors or a combination of both. Common dental problems associated with clefts includes anterior and posterior crossbites, hypodontia, malformation and abnormal eruption pattern.
  
  
  METHODS
  A girl, aged 15 years reported with a chief complaint of unesthetic appearance of her maxillary anterior teeth. She had unilateral cleft lip and palate and had received cheiloplasty and palatoplasty when she was in young age and rhinoplasty when she was 14 years of age. At pretreatment evaluation, she had concave profile with maxillary arch constriction and oroantral fistula and mesially tipped maxillary left canine.
  
  
  CONCLUSIONS
  This patient's treatment was unconventional, but it was successful in significantly improving her masticatory function and smile, along with favorable dental and facial results. Generalized esthetics and function were significantly improved in this patient without orthognathic surgery, and treatment results were stable 3 years after the appliance removal. Clinical considerations, sequencing of treatment phases as shown in this case report can be utilized while treating an adolescent with cleft lip and palate.
  
  
  CONCLUSIONS
  If the skeletal discrepancy is mild and esthetic concerns are minimal, dental compensation by orthodontic treatment alone might be recommended. The cephalometric analysis and prediction tracings provide further information for deciding whether a patient can be treated by orthodontics alone, or by orthodontics and an orthognathic surgical procedure. A change in axial inclination of the teeth can camouflage the skeletal relationship adequately. However, one should be cautious in a growing patient, because he or she might outgrow the dental correction so that ultimately skeletal surgery would be indicated.
authors.affiliation: Department of Orthodontics, Sibar Dental College, Guntur-520009, Andhra Pradesh, India. drasp77@yahoo.com
authors.forename: Sai Prakash
authors.initials: SP
authors.lastname: Adusumilli
authors.forename: P
authors.initials: P
authors.lastname: Sudhakar
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Mummidi
authors.forename: K V Baburam
authors.initials: KV
authors.lastname: Reddy
authors.forename: C H Hanumantha
authors.initials: CH
authors.lastname: Rao
authors.forename: B H V Rama Krishnam
authors.initials: BH
authors.lastname: Raju
mesh_terms: D000293:Adolescent; D064728:Alveolar Bone Grafting / Q000379:methods; D002508:Cephalometry / Q000379:methods; D002971:Cleft Lip / Q000601:surgery / Q000628:therapy*; D002972:Cleft Palate / Q000601:surgery / Q000628:therapy*; D003481:Cuspid / Q000473:pathology; D003830:Denture, Partial, Fixed; D004955:Esthetics, Dental; D005146:Facial Asymmetry / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008313:Malocclusion, Angle Class III / Q000628:therapy; D008409:Mastication / Q000502:physiology; D009957:Oroantral Fistula / Q000628:therapy; D010155:Palatal Expansion Technique / Q000295:instrumentation; D010347:Patient Care Planning; D010348:Patient Care Team; D063173:Retrognathia / Q000628:therapy; D012225:Rhinoplasty / Q000379:methods; D012904:Smiling